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Most people dread the hospital, not just for its bland food, but also for the smell of illness that hangs in the air. But with lifestyle changes leading to greater health problems, avoiding the hospital is fast becoming impossible. However, while hospital care may be inevitable, it isn't quite necessary for you to be hospitalised since now home healthcare providers across the country are making sure ward stays become shorter, or better still, entirely redundant. Companies like Portea, with services in 18 cities including all leading metro cities, TriBeCa Care in Kolkata, Homital in the National Capital Region and Health Care at Home India (HCAH) in North India are gradually changing the landscape of healthcare at home. Though doctor visits, sample collection for tests and physiotherapy have been offered at home for over a decade now, specialised treatment plans for the elderly, chronically ill and critical patients are still a new development. Armed with the latest tablets, software and specialised training, these healthcare providers can set up intensive care units, dialysis set-ups and radiology units at home. But while they may be substantially cheaper than hospital stays, packages offered for home hospitals are currently not covered by medical insurance.Ageing in comfort The one segment in home healthcare that is most popular is management of the elderly. With a rising number of nuclear families, there are fewer family members at home to take care of senior citizens. Assisted facilities may be the norm in the West, but Indians, brought up to respect and care for their seniors, are hesitant about sending parents and grandparents to old age homes. Rajah V Koppala, a doctor and regional medical director at Portea, explains that this is where homecare for the elderly is helpful. "We take the best practices of the West and mould it into a family set-up at home," he says. Such packages include physiotherapy, assistance in doctor visits, purchase of prescribed medication and making the home elderly-friendly. Koppala emphasises the need for a module for fall prevention, which includes exercises and lifestyle tips to improve balance and avoid injuries. "In the United States, 15 to 20 per cent long-term hospitalisations can be traced to falls, and these can be avoidable with proper exercise," he says. Geriatric care also overlaps with chronic illness treatments, which requires trained attendants. Gaurav Thukral, doctor and business development head at HCAH, says that unlike maids or attendants, their nursing staff goes through a proper training module. "Everyone we hire is trained for six weeks through simulations models, across clinical and technological elements," he says. This reduces chances of errors and increases accountability on the part of healthcare providers. What also leads to greater accountability is the software such healthcare providers use for uploading and sharing patient reports with their doctors. "Our staff carry tablets and all progress is captured in real time and then forwarded as a home report to the patient's doctor," says Thukral. While these may seem expensive, home healthcare for the elderly turns out cheaper than at assisted facilities. "Since we have no real estate cost, our packages are cheaper," explains Thukral.

Koppala says that while talking about costs, patients must remember the travel and time costs that they will save on. TriBeCa Care also offers treatments for sleep disorders, besides the emotional companionship that an attendant provides. Monthly packages for geriatric care at HCAH start at Rs 2,000 and go up to Rs 10,000.The ease of long-term care at your doorstep While most chronically ill patients are also elderly and health packages for the two segments may overlap, conditions like chronic obstructive pulmonary disease (COPD), kidney disease and heart conditions are common in younger age groups too. These conditions entail frequent visits to the clinic for consultation and specialised treatments. With home healthcare, the stress induced by frequent visits to the hospitals is significantly reduced, which makes recovery faster. "Patients have to wait sometimes for two hours just to show reports or get their dressing changed. Home healthcare is a blessing in such cases," says Rajesh Vasudeva, doctor and managing director at Homital. Services for such patients include changing catheters and colostomy bags, peritoneal dialysis and even radiation and chemotherapy at home for cancer patients. While peritoneal dialysis, which uses the stomach lining as a filter, is cheaper, most doctors and their patients prefer the conventional treatment of hemodialysis, which is a complex procedure. Portea's CEO and co-founder Meena Ganesh suggests that with the quality of water supplied by local authorities and the cost involved in purifying it, hemodialysis is only meant for "premium patients". For oncology care, she adds that Portea's services include post-radiation care and palliative or end-of-life care. "We don't replace the oncologists, we liaise with them. Our focus is on being a healthcare partner for life," she adds. For terminally ill patients, palliative care helps with reducing pain and helps them spend their last days with their families. Vasudeva says that for chronic illnesses in particular, "the constant monitoring prevents and reduces bad outcomes". Thukral also explains that chemotherapy is about 20 per cent cheaper when administered at home. While childbirth doesn't comprise an illness, new mothers, especially in nuclear families, struggle with the task of caring for their babies. Portea offer 'Canga and Roo' packages lasting for up to eight weeks that help new mothers to learn how to nurse their babies well, among other assistance offered by a trained nurse.

The critical healing touch

Surgeries often come with a long recovery time that needs constant medical attention. Healthcare at home companies now offer a host of post-operative services to speed up the recovery process. Several private hospitals also extend their ambit to a patient's home. "Special needs are discussed with the home care team so that they are able to professionally handle the patient in a home environment, away from the hospital," says Ashish Bhatia, COO, Fortis Healthcare Limited. The post-operative packages at Portea sometimes even involve a nurse clicking the picture of a surgical area and sharing it with the doctor over the software interface for complete medical supervision. In case the condition of a patient worsens, an intensive care unit, or ICU, can be set up in the patient's room at home by healthcare providers. "While an ICU in any leading private hospital can cost Rs 40,000-50,000 per day, the average cost of an ICU at home is around Rs 10,000," says Thukral.

While this may seem pocket-friendly, it is important to note that these services are currently not covered by any health insurance packages or government schemes such as ECHS and CGHS. But both Thukral and Ganesh say that the process to bring these services under the ambit of health insurance is under way.